Browsing by Author "Kahi, Charles"
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Item Adenoma Detection Rate in Asymptomatic Patients with Positive Fecal Immunochemical Tests(Springer, 2018-05) Kligman, Eugene; Li, Wenfang; Eckert, George J.; Kahi, Charles; Medicine, School of MedicineBackground and Aims The adenoma detection rate (ADR) is a powerful measure of screening colonoscopy quality. Patients who undergo colonoscopy for the evaluation of a positive fecal immunochemical test (FIT) have increased prevalence of colorectal neoplasia, but it is not known whether separate quality benchmarks are required. The aim of this study was to compare the conventional ADR to the ADR of colonoscopies performed for the evaluation of positive FIT, in asymptomatic average-risk patients. Methods Patients ≥ 50 years old who underwent colonoscopy for the evaluation of a positive FIT between January 1, 2013, and July 31, 2014, at a tertiary Veterans Affairs Medical Center were identified. FIT performed for any indication other than average-risk screening was excluded. The comparison group included average-risk patients ≥ 50 years old undergoing screening colonoscopy during the same time frame. The two groups were compared for ADR, advanced neoplasm [adenoma ≥ 10 mm, tubulovillous, high-grade dysplasia, CRC, sessile serrated polyp (SSP) ≥ 10 mm], CRC, and SSP detection after propensity score adjustment using a logistic regression model adjusted for endoscopist. Results There were 207 patients in the FIT group and 601 in the screening colonoscopy comparison group. After propensity score adjustment, ADR (72.9 vs. 50.0%, p = 0.003), number of adenomas per colonoscopy (3.3 ± 3.6 vs. 1.4 ± 2.3, p = 0.033), and advanced neoplasm detection rate (32.4 vs. 11.0%, p < 0.0001) were significantly higher in the FIT group. There were no significant differences in the number of CRC and the SSP detection rate. Conclusions In this cohort of average-risk Veterans, the ADR of colonoscopies performed for the evaluation of a positive FIT was higher than the ADR of screening colonoscopies. Patients with a positive FIT also had significantly more adenomas per colonoscopy and advanced neoplasms. These findings suggest that the quality of colonoscopies performed for a positive FIT is insufficiently assessed by the conventional ADR and requires additional quality metrics.Item Delphi Initiative for Early-Onset Colorectal Cancer (DIRECt) International Management Guidelines(Elsevier, 2023) Cavestro, Giulia Martina; Mannucci, Alessandro; Balaguer, Francesc; Hampel, Heather; Kupfer, Sonia S.; Repici, Alessandro; Sartore-Bianchi, Andrea; Seppälä, Toni T.; Valentini, Vincenzo; Boland, Clement Richard; Brand, Randall E.; Buffart, Tineke E.; Burke, Carol A.; Caccialanza, Riccardo; Cannizzaro, Renato; Cascinu, Stefano; Cercek, Andrea; Crosbie, Emma J.; Danese, Silvio; Dekker, Evelien; Daca-Alvarez, Maria; Deni, Francesco; Dominguez-Valentin, Mev; Eng, Cathy; Goel, Ajay; Guillem, Josè G.; Houwen, Britt B. S. L.; Kahi, Charles; Kalady, Matthew F.; Kastrinos, Fay; Kühn, Florian; Laghi, Luigi; Latchford, Andrew; Liska, David; Lynch, Patrick; Malesci, Alberto; Mauri, Gianluca; Meldolesi, Elisa; Møller, Pål; Monahan, Kevin J.; Möslein, Gabriela; Murphy, Caitlin C.; Nass, Karlijn; Ng, Kimmie; Oliani, Cristina; Papaleo, Enrico; Patel, Swati G.; Puzzono, Marta; Remo, Andrea; Ricciardiello, Luigi; Ripamonti, Carla Ida; Siena, Salvatore; Singh, Satish K.; Stadler, Zsofia K.; Stanich, Peter P.; Syngal, Sapna; Turi, Stefano; Urso, Emanuele Damiano; Valle, Laura; Vanni, Valeria Stella; Vilar, Eduardo; Vitellaro, Marco; You, Yi-Qian Nancy; Yurgelun, Matthew B.; Zuppardo, Raffaella Alessia; Stoffel, Elena M.; Associazione Italiana Familiarità Ereditarietà Tumori; Collaborative Group of the Americas on Inherited Gastrointestinal Cancer; European Hereditary Tumour Group; International Society for Gastrointestinal Hereditary Tumours; Medicine, School of MedicineBackground & aims: Patients with early-onset colorectal cancer (eoCRC) are managed according to guidelines that are not age-specific. A multidisciplinary international group (DIRECt), composed of 69 experts, was convened to develop the first evidence-based consensus recommendations for eoCRC. Methods: After reviewing the published literature, a Delphi methodology was used to draft and respond to clinically relevant questions. Each statement underwent 3 rounds of voting and reached a consensus level of agreement of ≥80%. Results: The DIRECt group produced 31 statements in 7 areas of interest: diagnosis, risk factors, genetics, pathology-oncology, endoscopy, therapy, and supportive care. There was strong consensus that all individuals younger than 50 should undergo CRC risk stratification and prompt symptom assessment. All newly diagnosed eoCRC patients should receive germline genetic testing, ideally before surgery. On the basis of current evidence, endoscopic, surgical, and oncologic treatment of eoCRC should not differ from later-onset CRC, except for individuals with pathogenic or likely pathogenic germline variants. The evidence on chemotherapy is not sufficient to recommend changes to established therapeutic protocols. Fertility preservation and sexual health are important to address in eoCRC survivors. The DIRECt group highlighted areas with knowledge gaps that should be prioritized in future research efforts, including age at first screening for the general population, use of fecal immunochemical tests, chemotherapy, endoscopic therapy, and post-treatment surveillance for eoCRC patients. Conclusions: The DIRECt group produced the first consensus recommendations on eoCRC. All statements should be considered together with the accompanying comments and literature reviews. We highlighted areas where research should be prioritized. These guidelines represent a useful tool for clinicians caring for patients with eoCRC.Item GA White Paper: Challenges and Gaps in Innovation for the Performance of Colonoscopy for Screening and Surveillance of Colorectal Cancer(Elsevier, 2022) Komanduri, Srinadh; Dominitz, Jason A.; Rabeneck, Linda; Kahi, Charles; Ladabaum, Uri; Imperiale, Thomas F.; Byrne, Michael F.; Lee, Jeffrey K.; Lieberman, David; Wang, Andrew Y.; Sultan, Shahnaz; Pohl, Heiko; Muthusamy, V. Raman; Medicine, School of MedicineIn 2018 the American Gastroenterological Association’s (AGA) Center for GI Innovation and Technology (CGIT) convened a consensus conference, entitled, “Colorectal Cancer Screening and Surveillance: Role of Emerging Technology and Innovation to Improve Outcomes.” The conference participants, which included more than 60 experts in colorectal cancer (CRC), considered recent improvements in CRC screening rates and polyp detection, persistent barriers to colonoscopy uptake, and opportunities for performance improvement and innovation. This white paper originates from that conference. It aims to summarize current patient- and physician-centered gaps and challenges in colonoscopy, diagnostic and therapeutic challenges affecting colonoscopy uptake, and the potential use of emerging technologies and quality metrics to improve patient outcomes.Item Individualized feedback on colonoscopy skills improves group colonoscopy quality in providers with lower adenoma detection rates(Thieme, 2022-03-14) Keswani, Rajesh N.; Wood, Mariah; Benson, Mark; Gawron, Andrew J.; Kahi, Charles; Kaltenbach, Tonya; Yadlapati, Rena; Gregory, Dyanna; Duloy, Anna; Medicine, School of MedicineBackground and study aims: Colonoscopy inspection quality (CIQ) assesses skills (fold examination, cleaning, and luminal distension) during inspection for polyps and correlates with adenoma detection rate (ADR) and serrated detection rate (SDR). We aimed to determine whether providing individualized CIQ feedback with instructional videos improves quality metrics performance. Methods: We prospectively studied 16 colonoscopists who already received semiannual benchmarked reports of quality metrics (ADR, SDR, and withdrawal time [WT]). We randomly selected seven colonoscopies/colonoscopist for evaluation. Six gastroenterologists graded CIQ using an established scale. We created instructional videos demonstrating optimal and poor inspection techniques. Colonoscopists received the instructional videos and benchmarked CIQ performance. We compared ADR, SDR, and WT in the 12 months preceding (“baseline”) and following CIQ feedback. Colonoscopists were stratified by baseline ADR into lower (≤ 34 %) and higher-performing (> 34 %) groups. Results: Baseline ADR was 38.5 % (range 26.8 %–53.8 %) and SDR was 11.2 % (2.8 %–24.3 %). The proportion of colonoscopies performed by lower-performing colonoscopists was unchanged from baseline to post-CIQ feedback. All colonoscopists reviewed their CIQ report cards. Post-feedback, ADR (40.1 % vs 38.5 %, P = 0.1) and SDR (12.2 % vs. 11.2 %, P = 0.1) did not significantly improve; WT significantly increased (11.4 vs 12.4 min, P < 0.01). Among the eight lower-performing colonoscopists, group ADR (31.1 % vs 34.3 %, P = 0.02) and SDR (7.2 % vs 9.1 %, P = 0.02) significantly increased post-feedback. In higher-performing colonoscopists, ADR and SDR did not change. Conclusions: CIQ feedback modestly improves ADR and SDR among colonoscopists with lower baseline ADR but has no effect on higher-performing colonoscopists. Individualized feedback on colonoscopy skills could be used to improve polyp detection by lower-performing colonoscopists.Item Long-Term Follow-Up of Colonoscopy Quality Monitoring(Wolters Kluwer, 2023-09-01) Patel, Feenalie; Dilly, Christen; Fayad, Nabil; Marri, Smitha; Eckert, George J.; Kahi, Charles; Medicine, School of MedicineIntroduction: High-quality colonoscopy is paramount for colorectal cancer prevention. Since 2009, endoscopists at our institution have received quarterly report cards summarizing individual colonoscopy quality indicators. We have previously shown that implementing this intervention was associated with short-term improvement in adenoma detection rate (ADR). However, the long-term effect of continued monitoring on colonoscopy quality is unclear. Methods: We conducted a retrospective study of prospectively administered quarterly colonoscopy quality report cards at the Roudebush Veteran's Affairs Medical Center between April 1, 2012, and August 31, 2019. The anonymized reports included individual endoscopists' ADRs, cecal intubation rates, and withdrawal times. Analyses were performed to determine slopes over time for each quality metric by physician and assess for differences based on whether ADRs were calculated quarterly or yearly. Results: Data from the report cards of 17 endoscopists who had performed 24,361 colonoscopies were included. The mean quarterly ADR (±SD) was 51.7% (±11.7%) and mean yearly ADR was 47.2% (±13.8%). There was a small increase in overall ADR based on quarterly and yearly measurements (slope + 0.6%, P = 0.02; and slope +2.7%, P < 0.001, respectively), but no significant change in individual ADRs, cecal intubation rates, or withdrawal times. Analysis of SD of ADRs showed no significant difference between yearly and quarterly measurements ( P = 0.064). Individual endoscopists' ADR SD differences between yearly and quarterly measurements ranged from -4.7% to +6.8%. Discussion: Long-term colonoscopy quality monitoring paralleled stable improvements in overall ADR. For endoscopists with baseline high ADR, frequent monitoring and reporting of colonoscopy quality metrics may not be necessary.Item Prevalence of sessile serrated adenoma/polyp in hyperplastic appearing diminutive rectosigmoid polyps(Elsevier, 2016) Ponugoti, Prasanna; Lin, Jingmei; Odze, Robert; Snover, Dale; Kahi, Charles; Rex, Douglas K.; Department of Medicine, IU School of MedicineBackground The American Society for Gastrointestinal Endoscopy recommends that distal colon hyperplastic lesions can be left in place without resection if adenomatous histology can be excluded with > 90% negative predictive value. However, some of the lesions could be sessile serrated adenoma/polyp (SSA/P), which is also precancerous. Aim Describe the prevalence of SSA/P in hyperplastic appearing diminutive rectosigmoid polyps. Methods We prospectively placed 513 consecutive diminutive rectosigmoid polyps that appeared hyperplastic to an expert endoscopist in individual bottles for pathologic examination. Each polyp was examined by 3 expert gastrointestinal pathologists. Results The prevalence of SSA/P in the study polyps ranged from 0.6% to 2.1%. The endoscopists lowest negative predictive value for the combination of adenomas plus SSA/P was 96.7% Conclusions The prevalence of SSA/P in diminutive rectosigmoid hyperplastic appearing polyps is very low. These results support the safety and feasibility of a “do not resect” policy for diminutive hyperplastic appearing rectosigmoid polyps.Item S0143 Association of Search Engine Queries for COVID-19 and Diarrhea With COVID-19 Epidemiology(Wolters Kluwer, 2020-10) Jansson-Knodell, Claire; Bhavsar, Indira; Shin, Andrea; Kahi, Charles; Medicine, School of MedicineINTRODUCTION: Coronavirus disease (COVID-19) is a far-reaching pandemic that has changed the landscape of human interaction. Gastrointestinal symptoms, such as diarrhea, are part of the spectrum of disease. Previous infectious disease studies have shown good correlation between online search engine queries and disease burden, thereby allowing tracking. We aimed to assess the relationship between Google searches for COVID-19 and diarrhea with COVID-19 epidemiology, including incidence and mortality. METHODS: Google Trends, a publicly available and free service that tracks online search frequency, was utilized to identify online searches for combined diarrhea plus COVID-19 from March 3, 2020 to May 4, 2020. These results were stratified by state and then compared with publicly reported incidence data from the US Centers for Disease Control and Prevention (CDC) for the same timeframe. A control search of other COVID-19 associated symptoms listed by the CDC was performed. Additional control searches of the individual search terms diarrhea and COVID-19 were conducted. Correlations between geographic location and epidemiologic trends were analyzed using the Pearson correlation coefficient. RESULTS: State-by-state searches for COVID-19 plus diarrhea were correlated with mortality reported as deaths per capita (R = 0.31; P = 0.03) [Figure 1], but not incidence reported as cases per capita (R = 0.19; P = 0.19). New Hampshire had the highest number of COVID-19 plus diarrhea searches while Alaska, Hawaii, Montana, and West Virginia had the lowest relative search frequency. Diarrhea was the second most searched symptom in conjunction with COVID-19 [Figure 2]. Fever and cough, which are thought of as more traditional upper respiratory viral symptoms, were also commonly searched. Diarrhea alone was more frequently searched than COVID-19 alone or COVID-19 plus diarrhea [Figure 3]. CONCLUSION: Our data show weak correlation between mortality and COVID-19 searches. This indicates that, for COVID-19, online search analysis is unlikely to be a good substitute for more traditional methods of patient testing, case tracking, and early detection. However, Google Trends of searches for COVID-19 plus diarrhea, in addition to being a marker for disease interest, may still be useful as part of a more complex model for tracking disease as they parallel search activity for COVID-19 in general.Item Strategies for Colorectal Cancer Screening(Elsevier, 2019) Ladabaum, Uri; Dominitz, Jason A.; Kahi, Charles; Schoen, Robert E.; Medicine, School of MedicineThe incidence of colorectal cancer (CRC) is increasing worldwide. CRC has high mortality when detected at advanced stages, yet it is also highly preventable. Given the difficulties in implementing major lifestyle changes or widespread primary prevention strategies to decrease CRC risk, screening is the most powerful public health tool to reduce mortality. Screening methods are effective but have limitations. Furthermore, many screen-eligible persons remain unscreened. We discuss established and emerging screening methods, and potential strategies to address current limitations in CRC screening. A quantum step in CRC prevention might come with the development of new screening strategies, but great gains can be made by deploying the available CRC screening modalities in ways that optimize outcomes while making judicious use of resources.Item The “valley sign” in small and diminutive adenomas: prevalence, interobserver agreement, and validation as an adenoma marker(Elsevier, 2016) Rex, Douglas K.; Ponugoti, Prasanna; Kahi, Charles; Department of Medicine, IU School of MedicineBackground Classification schemes for differentiation of conventional colorectal adenomas from serrated lesions rely on patterns of blood vessels and pits. Morphologic features have not been validated as predictors of histology. Aim Describe the prevalence of the “valley sign” and validate it as a marker of conventional adenomas Methods Three experts judged the prevalence of the valley sign in 301 consecutive small adenomas. Medical students were taught to recognize the valley and tested on their recognition of the valley sign. Consecutive diminutive polyps were video-recorded and used to validate the association of the valley sign with conventional adenomas. Results The prevalence of the valley sign in 301 consecutive adenomas <10 mm in size, determined by 3 experts, ranged from 35% to 50%. Kappa values for agreement among the 3 experts were 0.557, 0.679, and 0.642. Ten medical students were taught to interpret the valley sign and recognized it with accuracy of 96% or higher in 50 selected photographs of diminutive polyps. Four medical students evaluated video-recordings of 170 consecutive diminutive polyps for the presence of the valley sign. Kappa values for the interpretation of the valley sign ranged from 0.52 to 0.68 among the students. The sensitivity of the valley sign for adenoma ranged from 40.2% to 54.9%, and specificity ranged from 90.2% to 91.7%. The valley sign was strongly associated with adenomas (p<0.0001). Conclusions The valley sign is insensitive but highly specific for conventional adenoma in diminutive polyps. It may enhance classification schemes for differentiation of adenomas from serrated lesions based on vessels and pits.Item When and How To Use Endoscopic Tattooing in the Colon: An International Delphi Agreement(Elsevier, 2021) Medina-Prado, Lucía; Hassan, Cesare; Dekker, Evelien; Bisschops, Raf; Alfieri, Sergio; Bhandari, Pradeep; Bourke, Michael J.; Bravo, Raquel; Bustamante-Balen, Marco; Dominitz, Jason; Ferlitsch, Monika; Fockens, Paul; van Leerdam, Monique; Lieberman, David; Herráiz, Maite; Kahi, Charles; Kaminski, Michal; Matsuda, Takahisa; Moss, Alan; Pellisé, Maria; Pohl, Heiko; Rees, Colin; Rex, Douglas K.; Romero-Simó, Manuel; Rutter, Matthew D.; Sharma, Prateek; Shaukat, Aasma; Thomas-Gibson, Siwan; Valori, Roland; Jover, Rodrigo; Medicine, School of MedicineBackground & Aims There is a lack of clinical studies to establish indications and methodology for tattooing, therefore technique and practice of tattooing is very variable. We aimed to establish a consensus on the indications and appropriate techniques for colonic tattoo through a modified Delphi process. Methods The baseline questionnaire was classified into 3 areas: where tattooing should not be used (1 domain, 6 questions), where tattooing should be used (4 domains, 20 questions), and how to perform tattooing (1 domain 20 questions). A total of 29 experts participated in the 3 rounds of the Delphi process. Results A total of 15 statements were approved. The statements that achieved the highest agreement were as follows: tattooing should always be used after endoscopic resection of a lesion with suspicion of submucosal invasion (agreement score, 4.59; degree of consensus, 97%). For a colorectal lesion that is left in situ but considered suitable for endoscopic resection, tattooing may be used if the lesion is considered difficult to detect at a subsequent endoscopy (agreement score, 4.62; degree of consensus, 100%). A tattoo should never be injected directly into or underneath a lesion that might be removed endoscopically at a later point in time (agreement score, 4.79; degree of consensus, 97%). Details of the tattoo injection should be stated clearly in the endoscopy report (agreement score, 4.76; degree of consensus, 100%). Conclusions This expert consensus has developed different statements about where tattooing should not be used, when it should be used, and how that should be done.